Paying Attention to Medical Claims Issues

Top Tips When Choosing a Health Insurance Plan

One is never sure when a medical emergency will occur. Without prior preparation, medical costs may prohibit access to short-term and long-term health care. A key preparedness strategy is to have a health insurance plan. With a medical plan, you can access most health services at minimal costs. However, health insurance plans are not homogeneous. Here are some key tips that can help you select a good health insurance plan.  

Premiums and Deductibles

Premiums are the sums of money a policyholder pays to the insurer to maintain insurance coverage. This amount is payable monthly, quarterly, or annually. Notably, one has to pay the premiums whether or not they use the insurance for medical services. Thus, defaulting on payment on any basis may result in one losing the policy benefits. Therefore, it is critical to understand the cost of the premiums and assess your ability to pay. Significantly, find out the deductible you will have to pay before insurance pays the rest.  

Provider Network 

Health insurance is provided through a network of service providers. Typically, a health insurance plan will allow you to seek medical services from a primary medical facility or doctor within the provider's network. Thus, if you need to seek out-of-network benefits, you will have to pay for the services by yourself. Consequently, it becomes essential to determine whether your doctor and facilities around you are included in the provider's network.

Specialist Care 

In the medical field, there are specific issues that require a specialist. You may need a referral from your primary service provider before scheduling an appointment with the specialists. Therefore, seek clarity on the standard procedure. In this way, you can avoid situations of rejected claims due to technicalities. More so, there are situations where you may self-refer yourself to a specialist outside the providers' network. Thus, find out the co-pay amount and whether you need to pay more premiums. 

Waiting Periods 

Health insurance policy may not discriminate based on pre-existing medical conditions. However, insurance companies usually require people with certain pre-existing conditions to wait before making claims on their insurance. For instance, you may have to wait in case of cancer, cardiovascular, maternity, and dental care. The waiting duration varies across insurers. Thus, find out when you may qualify for benefits in case of a pre-existing condition. 

Medicine Coverage

Typically, not all medicines are covered by the insurance company. Thus, check with the insurance company on the types of drugs included in a plan before purchasing. The insurer will provide a list of medicines, usually called a formulary. As such, you can determine the much you will pay out of pocket by going through the formulary.

One must select the health insurance plan to avoid frustrations during claims. Importantly, consider the providers' network, premiums, coverage for medicine, and access to a specialist. Moreover, determine the waiting period for pre-existing conditions to avoid inconvenience.